Pharmacotherapy of Cushing's Disease and Acromegaly (drug-specific coverage)
Defines medical necessity criteria, benefit management (pharmacy vs medical), documentation and coding for drugs used to treat Cushing's disease, acromegaly, carcinoid syndrome, GEP-NETs and related neuroendocrine conditions for Premera Bluecross members.
Updated coverage criteria for Palsonify (paltusotine) to include the dose is limited to 60 mg daily and the quantity is limited to 60 tablets per 30 days; OR for individuals on concomitant use with a moderate or strong CYP3A4 inducer the dose is limited to 120 mg daily and the quantity is limited to 120 tablets per 30 days.
Updated coverage criteria for Isturisa (osilodrostat) and Recorlev (levoketoconazole) to include a quantity limit per 30 days.
Added generic long-acting octreotide depot with the same coverage criteria as Sandostatin LAR Depot (octreotide).
Clarified that the medications listed in this policy are subject to the product's FDA dosage and administration prescribing information and that non-formulary exception reviews may be approved up to 12 months.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.